Government

Medicare chief: Get savvy on prescription drug benefit

■ HHS Secretary Michael Leavitt says patients will expect doctors to answer questions about the new program.

By David Glendinning — Posted Aug. 22, 2005

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» The big 4-0
» Learn more, then teach
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Washington -- Medicare, a program that turned 40 years old this summer, is on the cusp of its first major makeover with the launch of the outpatient prescription drug benefit set for January 2006. Officials who are running the show say they need doctors' help to make sure the process goes smoothly.

Health and Human Services officials have hit the road on a nationwide bus tour hoping that the administration can reach out to doctors and seniors alike with vital information -- and reassurances -- about the new benefit. AMNews spoke with HHS Secretary Michael Leavitt about the effort.

Question: What are you trying to accomplish with this bus tour?

Answer: We are meeting with groups who are interested in helping seniors enroll. We're really at the early stage of what is going to be a profound national conversation that will take place in tens of millions of different settings. In many cases, it will be a doctor sitting with his or her patients talking through what their needs are and what plan will suit them best. We're informing that decision by meeting with groups and helping them begin to prepare for what will be many questions from seniors.

Q: Medicare drug plans will be unveiled in October, and beneficiary enrollment will start in the middle of November. What still needs to happen between now and then?

A: We're working on an enrollment system that will be able to accommodate the 41 million people who are eligible. We expect that in the first year 28 million to 30 million will actually enroll, and it will continue to grow from there. We're also working with literally hundreds of partners, but no one will be impacted more than the medical community itself. I recently saw a piece of research stating that more than 50% of seniors would go to their physician for information. So we are meeting with the medical associations, hospitals, community health centers to help them prepare for what inevitably will be a lot of people making inquiries and asking for help.

Q: What specific steps are you taking to make sure that the doctors know what to tell them when those seniors come in their doors?

A: We're asking the various medical associations all over the country to offer some training as part of their ongoing service to their members. We're providing them with information and resources -- from 800 numbers, to Web sites, to seminars -- that can train the staff and also the physicians themselves. But an important personal request I'm making to everyone I speak with is that they sit down with their own family. Most physicians will have a parent or a grandparent who will be in a setting where they need to make a decision. If they will help their own family, it will also empower them to help other people.

Q: Your department has once again sent on the road the nation's four top doctors -- CMS Administrator Mark McClellan, MD, PhD; Surgeon General Richard Carmona, MD, MPH; NIH Director Elias Zerhouni, MD; and CDC Director Julie Gerberding, MD, MPH. Is that an attempt to reach out especially to physicians and to the seniors who respond to what physicians tell them?

A: There's no question that we see the medical community as an important conduit to those who are going to be served by this benefit. Because they interact with [seniors] on a regular basis, we are working hard to ensure that information is in the hands of professionals.

Q: What sort of feedback have you been getting?

A: As seniors become aware of the benefit, there is growing enthusiasm. There are the inevitable questions that they need to ask and are asking: "How do I enroll?" "What does it all mean?" "What if I have drug coverage already?" We're doing our best not just to answer those questions directly but to train others to have that information.

Q: Are you pleased with the responses so far that you are getting from the insurers who are expected to administer this benefit?

A: A lot of people worried that we would not have enough plans signing up. That has simply not turned out to be the case. We will have multiple plans in every area, which suggests that the insurance companies think that this is a very good idea.

Q: Does this mean that we won't see many areas where there are fewer than two drug plans, forcing the government to offer a federal fallback plan?

A: I'd be very surprised if that happened anywhere.

Q: Physicians continue to worry that the plans' lists of approved drugs, or drug formularies, are not going to be extensive enough for them to prescribe all of the drugs that each patient needs. How have you been answering these concerns?

A: We've been assuring seniors that if a drug is medically necessary, it will be available to them through the drug plans.

Q: But physicians don't necessarily think that's true. Some of them worry that if certain vital drugs are excluded, they don't know if they can take on the administrative burden of fighting Medicare on behalf of their patients.

A: I think when they see them, they will be surprised in a positive way with the breadth of the formularies. The intent is for patients to have access to the medications with which they are accustomed. Will there be some cases of exceptions? I expect there will be. But for the most part, if a drug is medically necessary and has been prescribed by a physician, the plan will cover it.

Q: For the physicians you won't get to see personally, what can they expect over the next few months as they prepare for this big change in Medicare?

A: There will be no dearth of information. They will read about it in the newspaper, they will hear about it on the radio and on television, they will begin to see information turn up in their waiting rooms. We need to remember that when Medicare first started 40 years ago, they went through the same process. Medicare is now a part of our life. The same will be true with the prescription drug benefit. We're all going to have to put forth a little effort now to make certain that we understand the way that part of the system will work.

ADDITIONAL INFORMATION

The big 4-0

The health program that provides coverage for seniors and eligible people with disabilities turned 40 this summer. When it was launched, Medicare covered fewer than 20 million people for about $3 billion annually. In 2005, the program expects to pay $325 billion to provide health care for nearly 42 million people. Here are a few Medicare milestones:

July 30, 1965: President Lyndon Johnson signs a bill into law enacting the Medicare program. Former President Harry Truman is the first enrollee.

July 1, 1966: Medicare coverage begins. Roughly 19 million elder Americans automatically receive hospital insurance.

Oct. 30, 1972: President Richard Nixon approves legislation expanding Medicare to people younger than 65 with long-term disabilities.

Aug. 13, 1981: President Ronald Reagan signs the first in a series of bills to slow Medicare growth.

July 1, 1988: The Medicare Catastrophic Coverage Act of 1988 establishes an outpatient drug benefit and limits out-of-pocket costs. Congress repeals the major elements of the law the next year.

Dec. 19, 1989: President George H. W. Bush signs a bill replacing charge-based reimbursements for physicians with the Resource-Based Relative Value Scale.

Aug. 5, 1997: President Bill Clinton approves the Balanced Budget Act of 1997, reducing payments to a wide range of Medicare participants and launching private Medicare plans. Congress approves a series of bills in subsequent years restoring some of the cuts.

Dec. 8, 2003: President George W. Bush signs the Medicare Prescription Drug, Improvement and Modernization Act of 2003 into law.

Source: Kaiser Family Foundation

Learn more, then teach

The American Medical Association is involved with activities aimed at educating seniors and doctors about the upcoming Medicare drug benefit.

The AMA is a member of the Access to Benefits Coalition, a group of health care organizations led by the National Council on Aging. With a focus on seniors with limited resources, the coalition aims to help enroll millions of beneficiaries who will be eligible for extra government help with their drug bills starting in January 2006. More information is available online (link .

The AMA also is a member of the Medicare Rx Education Network, led by former Sen. John Breaux (D, La.) and designed as an information source for people who can enroll in Medicare drug coverage and those who want to educate others about it. More information is available through the network's Web site (link .

Physicians also can find information about the prescription drug benefit on the AMA's Web site, which summarizes key elements of the benefit legislation, provides links to government brochures and offers order forms for AMA educational materials. Interested doctors can go online (link .

Saying that January 2006 should usher in an expansion of Medicare benefits rather than a rollback, the AMA continues its lobbying effort to prevent physician payment cuts scheduled to start next year.

If Congress allows multiple consecutive years of cuts, some physicians will be forced to cut back on the number of Medicare patients they see and postpone needed investments in patient care, the AMA says.